Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones

Abstract

Mechanical bile stone lithotripsy on difficult bile duct stones could produce around 90% successful rate. Moreover, complications are minimal. This finding further confirms the significance of mechanical lithotripsy in the treatment of patients with difficult bile duct stones.

Ten years of Swedish experience with intraductal electrohydraulic lithotripsy and laser lithotripsy for the treatment of difficult bile duct stones: an effective and safe option for octogenarians

“…Stones that cannot be extracted using this first-line treatment are considered ''difficult'' bile duct stones. The second line of treatment, fragmentation of the stone by mechanical lithotripsy, has a convincing success rate of 80% to 90% [3][4][5][6][7]. The third-line methods of lithotripsy include intraductal electrohydraulic lithotripsy (EHL) and intraductal laser lithotripsy (ILL), both of which are aided by peroral cholangioscopy using a mother-baby-scope system [8][9][10].…”

Safely Stretching Our Options for Removing Large CBD Stones

“…The vast majority (91 %) could be completed during the initial ERCP. Adverse events (5 %) were mostly mild-to-moderate pancreatitis and bleeding, but also included cholecystitis, cholangitis, and duodenal and biliary perforation, similar to those reported for ML [3][4][5].…”

“…Leaving a plastic biliary stent in place with or without ursodeoxycholic acid therapy with subsequent ERCP is often successful [2]. Mechanical lithotripsy (ML) fragmentation combined with biliary sphincterotomy (EST) successfully removes many large stones [3,4]. Complications following biliary sphincterotomy and ML include bleeding, pancreatitis, and perforation and are usually mild and self-limited but on rare occasions can cause short-term morbidity or even death [5].…”

The Role of Choledochoscopy in Hepatopancreatobiliary Diseases

“…Additionally, to palpate or to determine the choledoch stones during laparoscopic surgery is difficult, even if possible, so it is important to diagnose them before surgery. Similarly, a mean 10% of false negative visualization or exploration rate of choledochal stones during open or laparoscopic surgery may create need for choledochoscopy for the biliary system stones [3,7,[16][17][18][19][20]. In intraoperative choledochoscopy, the stones or stone particles can be directly seen, as well as the stones are easily differantiated from blood cougulum or air bubbles [3,11].…”